Staff, members and governors’ magazine // June 2018Royal Free London

NHS Foundation Trust

What matters to you?

Sir David SlomanGroup chief executive

Hello and

Key to abbreviations:Barnet Hospital: BHChase Farm Hospital: CFHRoyal Free Hospital: RFHRoyal Free London: RFL

Follow our Twitter account @RoyalFreeNHS to see what our patients and staff are saying about us

welcometo the June edition of our monthly staff, members and governors’ magazine.I’m pleased to let you know that this month we launched our new objectives which are designed to help us achieve our organisation’s goals.

They include quality improvement (QI), meeting national standards and the roll out of clinical practice groups to reduce unwarranted variation. You can read the full details on p8.

Trust staff took part in international ‘what matters to you?’ day, an initiative that encourages healthcare staff to ask colleagues and patients ‘what matters to you?’, rather than ‘what’s the matter with you?’ We’ll use your feedback to help us provide better patient-centred care and improve staff satisfaction. Look out for updates across all our communications channels.

From cutting-edge pharmacy robots to new coffee shops, rest areas and vending machines, the final touches are being put into the new Chase Farm Hospital – see p4 to find out what’s new.

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Meet our new chief medical information officers (CMIOs) who have started the important job of helping RFL to achieve its ambition to become the most digitally advanced trust in the NHS by 2020.

Consultants Penelope Smith, Tony Wolff and Mark Furman, alongside trainee doctors Tim Yates, Jay Mehta and Amanpreet Sarna have started working across our hospital sites.

Clinicians are at the heart of this digital transformation, ensuring that new digital technologies will be designed to reflect what they – and their patients – need to make their experience of delivering and receiving healthcare at the RFL a positive one.

Penelope and Tim will be leading the work at the RFH, Tony and Jay will be based at BH and Mark and Amanpreet will be working across CFH to engage frontline staff.

The first step in the trust’s digital journey is the introduction of a new electronic patient record (EPR), which will deliver better, safer, faster care by guiding clinicians to evidence-based treatments thanks to the introduction of digitised patient pathways.

The new EPR will be phased in across all three of our main hospital sites between autumn 2018 and the end of 2019.

It will be at the heart of how we deliver care to our patients and it will go live at CFH and BH in 2018, replacing paper records over the next two years.

Tony, CMIO and consultant intensivist at BH says: “Our role as CMIOs will be to communicate to staff members about what is happening…we want to prepare people for what is coming in terms of the EPR roll out as well as listen to their feedback.

“We really want to encourage people to take up opportunities to see how the new system works.

“I think gathering data is incredibly valuable and in order to really improve quality it’s very important.

“With the roll out of the new EPR we will be able to start recording everything that is happening. The goal is to reduce unwarranted variation to ensure all patients have the same high quality experience wherever they are treated in the Royal Free London group.”

Penelope, CMIO and consultant physician in acute medicine and infectious diseases at RFH says: “As a CMIO I want to get out and about to see how technology is affecting daily workflows.

“We are responsible for helping clinicians to use digital technology.

“I think we need to look in detail about how we access data and make it meaningful to help improve outcomes.”

Our chief medical information officers are raring to go

(left to right) top: Tony Wolff, Penelope Smith and Amanpreet Sarna bottom: Mark Furman and Tim Yates

CMIO Jay Mehta

Pharmacy robot installed at new Chase Farm Hospital

Processing up to 7,200 medicine packs an hour, a new cutting-edge robot in the new CFH is set to transform the pharmacy department.

The machine’s two robotic heads are able to read barcodes, select the appropriate medicines and deliver them down a chute to pharmacy staff.

The picking head (claw) picks out and delivers prescriptions in one sweep by selecting different packs and outputting them all together. By having two heads the machine is able to deliver prescriptions at the same time as it replenishes ward boxes and leads to a more rapid supply of medicines.

The robot will speed up the work of the pharmacy team thanks to an automated loading system that will process incoming goods and load them to the correct shelves.

Teri Emery, CFH dispensary manager, said: “We’re delighted with the new pharmacy robot. It will streamline how we work and help us support patients and the wards better by saving staff time and ensuring that we’re rapidly and accurately delivering medicines.

“Working closely with the redevelopment team we have been able to select a new pharmacy robot that will mean that CFH is at the forefront of this technology.”

Any risks of the machine breaking down are mitigated by the two heads, allowing repairs to be undertaken, and two PCs installed to ensure that any downtime doesn’t impact on the pharmacy team’s work.

The new machine, a double picking head pharmacy robot by Becton Dickinson, was selected and designed by the pharmacy team who are now working to get it up and running in time for the opening of the new hospital. In the autumn a name for the new machine will be selected by the pharmacy team.

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What shops and food areas will be available at the new hospital?The new CFH will have a Costa coffee outlet which will be located in the main entrance and will spread across two floors.

The site will also have a Little fresh shop on the ground floor next to the coffee shop which will sell a range of products including hot and cold foods, stationery and magazines and newspapers. Both Costa and Little fresh will open on 30th July when Greenfields restaurant and the Clock Tower cafe will close.

Staff will have a generic rest area with tables, seating and kitchen facilities including sinks, microwaves and vending machines serving both snacks and hot and cold drinks.

There will be additional vending machines dotted throughout the building in meeting and hot desk areas, theatre rest rooms and the urgent care centre adult waiting room.

CFH question of the month

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pharmacy robot

Patient’s mystery symptoms unlocked

thanks to app warning

A woman diagnosed with a life-changing kidney condition has praised the technology which enabled doctors at the RFH to discover the problem significantly faster and begin vital treatment.

Beata Zakowska was flagged up with acute kidney injury (AKI) alert via the Streams app being pioneered at the RFH. The app – an instant alert system – detects patients at risk of AKI or who have already developed kidney injury.

Beata had been feeling unwell for a few weeks and had visited her GP and another hospital.

“It soon became clear to me that this was different from general tiredness – there was swelling around my calves and I was in so much pain I just couldn’t walk.

“I went to the GP…they thought it might be an underactive thyroid or a lack of vitamins so started treating me for that.”

But this didn’t seem to make any difference and in increasing amounts of pain Beata went to hospital, where doctors struggled to find the cause of her illness and referred her back to her GP for further tests.

Beata said: “When the GP saw the results of the blood tests he’d taken he told me to go straight to the Royal Free Hospital’s emergency department as he thought there could be a problem with my kidneys.”

From the moment Beata’s bloods were taken at the RFH the AKI alert meant that Beata was fast-tracked directly to the kidney team.

Sally Hamour, RFH specialist kidney consultant, said: “It is very unusual for someone so young to have these kinds of results, but the Streams app immediately flagged up AKI to us from her blood tests.

“That meant Beata had the immediate support of a specialist team and we were able see her and arrange for a kidney biopsy the following day, all within an hour of getting that alert.

“Beata now has a diagnosis – she has vasculitis, a rare condition which is an inflammation of the blood vessels.”

AKI affects one in six in-patients; however, it can be difficult to detect and treat quickly.

Streams, which was developed in partnership with technology company DeepMind, uses a range of test result data to identify which patients could be in danger of developing AKI and means doctors and nurses can respond in minutes rather than hours or days – potentially saving lives.

More than 26 doctors and nurses at the RFH are now using Streams and each day it is alerting them to an average of 11 patients at risk of acute kidney injury.

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RFH patient Beata Zakowska

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RFH therapy team ‘What Matters to You Day’ pledges

Having a laugh at work, having a supportive team and being treated with respect.

These are some of the examples you gave during an international day which encourages healthcare staff to answer the question: ‘What matters to you?’

The aim of the day, which took place on 6 June, was to try to understand what really matters to our patients and staff so we can provide better patient-centred care and improve staff satisfaction.

Focusing on staff

Evidence shows that happy staff provide a higher quality of care to patients, and the day was about learning what’s important to staff and what can be done to make their time at work more enjoyable.

Photo booths and postcards

The Royal Free Charity sponsored photo booths for the day – at BH, CFH and the RFH, staff were also encouraged to tell us what matters to them by completing a postcard questionnaire.

Additional events took place at Edgware Community Hospital, St Pancras Hospital, Tottenham Hale and the Enfield Civic Centre.

Janadeen McDonald, senior sister, endoscopy, at CFH says: “What matters to me is being able to have a laugh at work with my colleagues and also knowing that I have support from my line manager.”

Trupti Shah, CFH staff nurse in endoscopy, agrees and says that it matters to her to make sure that ‘patients have had a good, positive experience.’

Farah Martinelli, a dialysis and out-patient administrator at BH, says: “It’s a satisfying day when the patients are happy, then the staff are happy too.”

Emma Korca, BH based paediatric junior sister, adds: “What matters to me is that my team are safe, happy and able to do the job they love properly.”

Lauren Geddes, clinical lead respiratory physiotherapist at RFH, says: “I have a really good day when we are well staffed, there is laughter in the office, when we can find time as a team to share our stories, and when people around me are positive and open to suggestions.

“A ‘thank you’ from a patient always makes my day.”

Staff celebrate ‘What Matters to You Day’ at the RFH with group chief executive Sir David Sloman

Annie Panakhal, Lana Robinson, Rhea Tamondong, endoscopy nurses, CFH

The RFH MSK team embracing ‘What Matters to You’ 2018

‘Asking our staff: what matters to you?’

Clinical practice educator Olly Carpenter, RAF flight sergeant Susan Jenkins and RAF infection control nurse Beth Cummins displaying the air transport isolator - used to transfer UK patients with viral hemorrhagic fever to our high level isolation unit at the RFH.

Our winning stallholders from the nursing and midwifery event-staff nurses Dorota Wojcik and Jagna Palczewska from interventional cardiology.

Winning stallholders at RFH- interventional radiology nurse Arnell Colongon and senior sister Regina Navato.

(left to right) Indira Khandal, clinical practice educator, Carmen Mirabelli Badenier, healthcare assistant, Goretti Doolan, ward sister, Jaya Alargarsamy, nursing associate, Sarah Dwama, student nurse

Sahara Maharjam, operating department practitioner and Elizabeth Nwandu, deputy team leader, theatres

The RFH MSK team embracing ‘What Matters to You’ 2018

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Infection control nurse Kine Jul-Larsen showcases infection control at CFH nursing and midwifery day.

Student nurses Tika Parajuli Bhattarai and Maryam Rouzkhosh

Orna Lee, junior sister on Canterbury ward at CFH celebrating nursing and midwifery week.

Staff celebrating Nursing and Midwifery week at BH with chief executive Dr Steve Shaw.

We celebrated the annual event, which incorporates international nurses day and international day of the midwife, by showcasing best practice and the great work we do.

A series of events and activities across all of our hospitals were held during the week, bringing together and celebrating all staff working in these professions.

Our celebrations included clinical practice stall events, Cordwainers Scholarship awards and a nursing and midwifery assistants’ awards ceremony.

Speaking during the week, group chief nurse Deborah Sanders, said: “It’s been a joy to take some time to celebrate the nurses and midwives of the RFL. I am so proud of you all – thank you.”

Nursing and midwifery week 2018

3…2…1… action!We celebrated Dementia Action Week 2018 in May by making changes to improve everyday life for people affected by the condition.

Kick starting the week, the Royal Free Radio launched its pioneering radio show – the ‘Sundown Sessions’ – to help patients with dementia and ward staff manage the phenomenon known as ‘sundowning’.

Sundowning is the clinical term used to describe the changes in behaviour that occur in people with dementia in the evenings, with some people experiencing growing agitation or anxiety at this time.

Danielle Wilde, dementia lead at the RFL and co-creator of the radio session, said: “I had an idea to record a series of radio programmes called the ‘Sundown Sessions’ that could be aired daily and could be used as a therapeutic and reminiscence show aimed at building engagement between staff and patients.”

The radio show is the first of its kind and the Royal Free Radio will air the show every day from 5-6pm on patients’ bedside systems (Hospedia, channel 1), playing music and memories from years gone by.

A number of local activities also took place during the week. At BH, staff and patients took to Lindsey’s café for a singing and dancing session. Make-overs were also arranged for patients with dementia across sites and ‘The Royal Free London dementia handbook’ for carers was launched.

For more information about dementia care at the RFL please contact Danielle Wilde, trust dementia lead: daniellewilde@nhs.net

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Our trust objectives for 2018/19Our trust objectives for 2018/19 have been launched to help us achieve our organisational goals.

The objectives form a key part of the work of the trust board and its committees, and if managers use them in appraisals and personal development plan (PDP) conversations, this will help further align the work we all do behind a common strategy.

Our objectives, all underpinned by our approach to quality improvement (QI), are to:

• focus on quality by aiming for all sites being rated outstanding in the Care Quality Commission’s well-led framework and working to eliminate ‘never events’

• focus on performance and meeting national standards – improving A&E waiting times, meeting the national cancer access targets and reducing waits for non-emergency care

• provide better value for patients and taxpayers by achieving our targets for financial improvement, opening the new CFH and developing our partnership with North Middlesex University Hospital (NMUH)

• be a stronger, more resilient organisation by embedding 20 clinical pathways to reduce unwarranted variation and by focusing on promoting inclusion across our workforce. We’ll also build stronger local relationships with health and care providers and harness the benefits of technology to improve the care we provide to patients

For more information please contact your line manager or email the strategy team: rf.planning@nhs.net.

Fritzie Cencil, clinical practice educator, offers make overs on 10 North, RFH

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Cath lab showcased in India The world class work of our interventional cardiology team was showcased internationally to 2,000 cardiologists in India last month.

In a live satellite transmission from the cardiac catheter labs at the RFH, two live cases were streamed to the Cardiological Society of India’s national interventional conference in Hyderabad.

Dr Roby Rakhit and Dr Tim Lockie (pictured) demonstrated a novel type of stent device that is able to uniquely adapt to large vessels that have changes in size. The procedure was performed using state of the art imaging that uses a technique called optical coherence tomography (OCT), which we’ve got particular expertise in.

The link up meant that cardiologists in India could be talked through the procedures step by step and to ask questions throughout.

Dr Rakhit, consultant interventional cardiologist, says: “This was a tremendous opportunity to showcase the expertise and work of the cath lab to an international audience. The chance to interact with other cardiologists while we were undertaking the procedure meant that we could give a much more interactive demonstration of the techniques shown.”

Surgeon Nadine Hachach-Haram has received a British Empire Medal for her innovative work in the field of surgery and medicine during her time at the Royal Free Hospital.

In 2015, Nadine co-founded Proximie, an augmented reality platform that allows doctors to be virtually transported into any clinical setting in the world. This helps doctors from across the globe to interact and mentor each other for new procedures and techniques.

It is used at the Royal Free Hospital to teach undergraduate and postgraduate students and to deliver peripheral specialist care.

Nadine, who worked at the Royal Free Hospital between 2014 and 2017, said: “I am incredibly proud and humbled to receive this award so early in my career. I’m passionate about innovation in healthcare and how we can leverage technology to improve the care our patients receive here in the UK and across the world. I am particularly grateful to Professor Mosahebi at the Royal Free London who has been an inspirational mentor to me over the last four years.”

The achievements of a Royal Free Hospital matron who showed ‘outstanding leadership’ during the Ebola outbreak in 2015 have also been recognised by the Queen.

Breda Athan was awarded an honorary MBE and praised for her ‘outstanding leadership on infectious diseases’.

Breda is lead matron of the high level isolation unit at the Royal Free Hospital, where patients with the most dangerous infections are treated.

Staff recognised in Queen’s honours

Breda Athan, lead matron, high level isolation unit, RFH

Nadine Hachach-Haram

A new adult assessment unit (AAU) has opened at the RFH under the management of medicine and urgent care.

The unit, which opened last month, provides rapid assessment and turnaround for patients so that they can be discharged within 24 hours or transferred to an in-patient bed.

The unit is located on the lower ground floor next to the emergency department (ED), where building work has been on-going for some months.

The ED clinical decision unit (CDU) has moved into the AAU, creating nine beds, and an additional nine beds have been opened following the closure of ward 6E.

Although the new AAU currently has 18 beds, capacity is set to be expanded to 30 beds in winter 2018.

Dr Tara Sood, consultant lead, A&E, said: “The AAU is an exciting opportunity for us to develop a new way of working with patients who come to hospital with an acute emergency.

“It provides an area where patients have direct access to key investigations and treatments which will help to streamline the patient journey, avoiding delays in patient care, and reducing the length of time that patients need to stay in hospital.

“Many speciality teams are developing pathways to manage their patients in the AAU, alongside the acute medical and emergency department teams. We are developing a multi-disciplinary and multi-professional approach to patients being managed in a timely manner by the right clinical team.”

Kate Slemeck, RFH chief executive, said: “This is the culmination of a five year planning and four year building programme. This unit, co-located with the emergency department will transform the way we care for patients supporting early diagnosis and decisions regarding next steps for care or discharge.

“I want to give my thanks to everyone who has been involved in the planning and who will lead and deliver the care in the unit.”

Sarah Gough, senior sister in AAU said: “In AAU we have multiple resources and teams in place in order to help facilitate discharges, such as: TREAT, PACE, therapies, rapid response and social services attending our board rounds.

“Whilst patients are in AAU they are not considered ‘admitted’ into hospital, meaning packages of care are much easier to restart.”

“We select our patients carefully, using our set criteria and have been discharging majority of our patients back home each day.

For further information about the new AAU, please contact the medicine and urgent care management team on x 33559 or email: Jackie.Robinson6@nhs.net or Camillawiley@nhs.net.

New adult assessment unit opens

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RFH chief executive Kate Slemeck opening the new AAU

(left to right) Lindsay Sanders, lead occupational therapist, Haydee Reforma-Bergado, junior sister, Lucy Bossman, lead domestic, Cecilia Mlungu, junior sister, Sarah Gough, senior sister

Dates for your diaryChief executive’s briefingsThis is your opportunity to hear the latest news from around the trust and ask any questions you may have.

21 June, 10.30 - 11am, lecture theatre, CFH

26 June, 12.30 - 1pm, PSH, RFH

28 June, 9.30 - 10am, conference room 2, 10th floor, ECC

Disability Awareness Week Carers, patients with learning disabilities and staff from community learning disability teams will be holding sessions and giving presentations across the trust throughout the week.

There will be stalls teaching Makaton sign language and giving advice.

18-22 June

NHS 70th anniversary celebrationsThe Royal Free Charity will be holding tea parties on 5 July to celebrate the 70th anniversary of the NHS at each of the main RFL sites to say thank you to staff and celebrate the fantastic work of the NHS.

All staff are invited and if they are unable to leave their ward or department the charity will bring the party to them.

3 - 5pm, hospital restaurant, RFH

2 - 4pm, level 3 corridors, BH

11am - 1pm, Highlands Wing, CFH

More information on all dates is available on Freenet events.

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Over 150 participants took part in the final day of the 2017/2018 Step up to lead programme. They came together to reflect on and celebrate what they had learnt and achieved.

The annual trust wide programme requires staff to attend six leadership modules and complete a QI project.

Last month’s event showcased some of the QI work undertaken by the group. These included:

• the prevention of hepatic encephalopathy (HE) in patients with chronic liver disease

• improving inpatient discharge by reducing booking errors; improving turnaround times of C-diff samples by using hospital air chutes to transport samples

• developing and using an automated ‘less than full time pay’ calculator for new junior doctors’ contracts, to ensure junior doctors are paid correctly.

The organisational development (ODD)team is currently advertising for the 2018/19 Step up to lead programme, as well as other leadership development programmes (see box).

Please visit the ODD leadership pages on Freenet for more information or email rf-tr.leadership@nhs.net.

Step up to Lead

Leadership development programmes – applications open

Step up to lead For staff not yet leading people but preparing for the next step up and who have the potential to lead others. Two cohorts will run from October to April 2019. There are 25 places on each cohort.

Licence to lead and manage For staff who are either new to leading and line managing or those who would like to brush up and refresh their leadership skills. Two cohorts will run from September 2018 to May and June 2019. Each cohort has 12 places.

Leading LeadersFor staff (clinical and corporate) who are responsible for leading a service. Two cohorts will run from October 2018 to June 2019. Each cohort has 16 places.

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Director and governor visits Our go-see programme creates regular opportunities for directors to pair up with governors and visit different areas across our hospitals.

In May, non-executive director, Akta Raja, visited the haematology and oncology department at the RFH and met staff as she was shown around 2 North A, outpatients and 11 East.

During the visit she met Keith Hunt, complementary therapy coordinator, who described the massage service that was available to patients undergoing chemotherapy.

She said that she had received very positive feedback from the visit.

“Patients described the service’s patient focus and receiving an excellent experience.”

60 seconds with…Claire Carson, head of chaplaincy and spiritual careCan you introduce yourself and tell us a bit about your background?I’m originally from Newcastle Upon Tyne and was brought up in an agnostic and atheist family. It was my teenage rebellion to go to church. I was fascinated by this building I walked passed each day which I wasn’t allowed to go in. My curiosity and my love of music eventually got me in there.

I was ordained as an Anglican priest 15 years ago.

How long have you been a chaplain?I’ve been a healthcare chaplain for 11 years. My first post as a hospital chaplain was at the RFH from 2007 to 2010.

My interest in healthcare chaplaincy started while I was studying theology and psychology at university. I am particularly interested in paediatric chaplaincy in the UK and palliative care in Africa. I have developed links with Hospice Africa Uganda over the last few years and visited several times to explore what spiritual care means there.

What do you do in your spare time?I love music and art. Music particularly has been a big part of my life. I have spent many years in orchestras and bands, playing clarinet and alto saxophone. I play piano too, but these days mainly for my own relaxation. I hope to bring lots more music and art to the chaplaincy-spiritual care department.

Tell us about your role… Expect the unexpected seems the best way to approach my work. I can come into work with one plan and almost certainly end up involved in something completely different. The day might start with a baby’s funeral, then a teaching session, a visit to a patient who has

been referred, volunteer supervision, a pregnancy loss, staff support… on the more unusual days I might be called to arrange an emergency marriage or a baptism.

What does the team offer?As a chaplaincy-spiritual care team we want to encourage compassionate, holistic care for everyone, being respectful of diversity and celebrating all of our traditions.

We offer spiritual, religious and pastoral support to patients, visitors, volunteers and staff. We are here for people of all faiths and beliefs. You certainly don’t have to think of yourself as religious to use our service.

What do you enjoy most about your job?I love the variety and unexpected nature of my work. I enjoy working in a multi-faith and belief team. It’s great sitting in the office chatting with a rabbi, imam, roman catholic priest and whoever else may be there.

I meet some amazing people. It’s a real privilege to listen to their stories and be invited into their lives, even if only for a few minutes.

What is the most rewarding part of your job?

Every day my job reminds me how precious and fragile life is. So many people I talk to wish they had been able to talk about death with their family and friends sooner. Being open, honest and having courage to talk about death and dying can transform the way we live.

Akta Raja, non-executive director

Haematology and Oncology treatment suite team 2 North A (left to right) Rodilina Dayandante, healthcare assistant, Vered Prager, staff nurse, Angelica Cowell, healthcare assistant, Lisa Tripoli, junior sister, chemotherapy, James Ogunsanya, administrator, Marvie Omayao, junior sister, chemotherapy, Helen Kibromjunior, sister, chemotherapy